PB2324: USE OF COMBINATION OF THALIDOMIDE, CYCLOPHOSPHAMIDE AND DEXAMETHASONE IN PATIENTS WITH REFRACTORY/RELAPSED NON-HODGKIN LYMPHOMA: A PALLIATIVE CHEMOTHERAPY STRATEGY.
Authors: Celia Martinez, Lisa Yuen, Jessica Brady, Mary Gleeson, Mikhaeel George, Karen Stanley, Fields Paul, David Wrench
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: The increase in older, less fit patients with lymphoma and the increasing cost of healthcare has introduced a new reality physicians must face: the decision of the best non-intensive treatment for non-fit patients to reduce toxicity and prioritize their quality of life. Novel therapies are improving outcomes in relapsed refractory non-Hodgkin lymphoma (R/R NHL). However, frail patients are not eligible for these and less intensive approaches are indicated for disease symptom control. The cyclophosphamide, thalidomide, dexamethasone (CTD) regimen is widely used in multiple myeloma but experience in lymphoma is limited. Aims: Assess efficacy and toxicity of CTD in R/R NHL. Methods: Retrospective study of patients treated with CTD (C 500mg days 1, 8, 15; T 100mg days 1-28; D 20mg days 1-4 and 12-15) for a diagnosis of R/R NHL treated at Guy’s Hospital. Fifteen patients were from this centre and 3 were referred from other hospitals. Demographic data, information related to the patient’s baseline status, toxicity and response to treatment were analysed. Response to treatment could not be assessed in 7 patients. Progression was clinically in 2 patients, in 4 cases with PET/CT and in one with MRI. All statistical tests were performed with the IBM SPSS Statistics v. 26.0. Quantitative variables are expressed through variables of central tendency, median, and interquartile range. Results: A population of 18 patients with NHL treated with CTD schedule between 2012 and 2019 was analysed: 55.6% (n=10) females and 44.4% (n=8) males. Median age was 72 (range 68-79), 89% (n=16) were over 60 and 16.7% (n=3) were over 80. One patient started chemotherapy without thalidomide due to previous neuropathy. Diagnoses included: diffuse large B cell lymphoma (DLBCL) not otherwise specified 38.9% (n=7); DLBCL transformation of indolent lymphoma 27.8% (n=5); Angioimmunoblastic T-cell Lymphoma 11.1% (n=2); and single cases of Peripheral T-cell lymphoma, not otherwise specified; Plasmablastic lymphoma; DLBCL high-grade B-cell lymphoma with MYC and BCL2 rearrangements; and HHV8-associated multicentric Castleman’s disease. Median time from diagnosis was 19 (7-52) months. Patients had received a median of 2 (1-3) previous lines of treatment, including autologous haematopoietic stem cell transplantation 5.5% (n=1). Pre-treatment ECOG performance status scores included 0 (n=1, 5.6%), 1 (n=8, 44.4%), 2 (n=6, 33.3%) and 3 (n=3, 16.7%) with advanced disease in the majority (stage 3 in 11.1% (n=2) and stage 4 in 88.9% (n=16)) while 77.8% (n=14) had progressed and 5.6% (n=1) had stable disease. A median of 2 (1-6) cycles of CTD were administered. Toxicity was haematological in 33.3% (n=6) of cases: neutropenia 27.8%; (n=5) and thrombopenia 5.55% (n=1). Non-haematological in 22.2% (n=4): neuropathy 11.1% (n=2), osteoporotic collapse 5.5% (n=1), gastrointestinal symptoms 5.5% (n=1). All were grade 1-2 and dose attenuation done if indicated. Duration of response is illustrated in Figure 1A with a median of days of 96 (69-255). Median overall survival was 3 months (CI95%: 1-5) with 2 patients surviving over 17 months (Figure 1B).Summary/Conclusion: In frail, elderly, pre-treated patients with R/R NHL, CTD was well tolerated and easily managed with moderate efficacy. It further supports the use of oral regimens including other imids in end stage disease and may provide a convenient and cost-effective option in resource limited healthcare systems. Keywords: Lymphoma therapy